"We never leave anyone behind": a qualitative study of stakeholders' perspectives on disability-inclusive maternity care in Cambodia.

backgroundDespite some progress towards disability rights in Cambodia, women with disabilities still experience inequitable access to maternity care. To provide a context-specific understanding of this complex issue, we conducted a study exploring the perspectives of key stakeholders from across the health and disability sectors regarding disability-inclusive maternity care in three locations of Cambodia: Phnom Penh, Kampong Speu, and Kampot.

methodsThis study employed a qualitative descriptive approach, using semi-structured interviews with twelve government and non-governmental stakeholders. Data were transcribed verbatim, translated from Khmer to English, anonymised, and thematically analysed using the WHO Quality of Care framework.

resultsAlongside presenting findings relevant to (1) Perceptions and conceptualisation of disability-inclusive maternity care, results were thematically presented across the relevant WHO Quality of Care framework components, including (2) Competent and motivated human resources; (3) Essential physical resources; (4) Provision of care; (5) Experience of care. All stakeholders unanimously agreed that maternity care services for women with disabilities were not inclusive, including the absence of disability-inclusive maternity care policies, guidelines and training for the healthcare workforce. Barriers to access were exacerbated when health services lacked sufficient human resources, equipment and referral systems to accommodate the needs of this population. Government stakeholders conceptualised disability-inclusive care as equal treatment without discrimination. Some commended existing social protection funding and considered it adequate to support access to maternity care. In contrast, non-governmental stakeholders emphasised that equitable maternity care requires both accessible infrastructure and services and more effective implementation of social protection measures.

conclusionThis study provided the context of the disability-inclusive maternity care in Cambodia from the perspectives of key stakeholders. The study highlighted that the Cambodian health system was inadequately responding to the maternity care needs of women with disabilities. A collaborative approach among government staff and relevant stakeholders is needed to develop a disability-inclusive maternity care policy and ensure effective implementation, monitoring, and evaluation. Additionally, capacity building for healthcare providers with disability inclusion is essential to ensure that women with disabilities are not left behind when they access maternity care.